SHM Converge Scientific Abstract ePoster Gallery-Tap Into It: A Rare Case of Primary Peritoneal Carcinomatosis

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This case describes a 67-year-old woman with a history of GERD and treated breast cancer who presented with severe epigastric pain radiating to her chest and jaw, along with one month of abdominal distension, anorexia, and nausea/vomiting. Her initial cardiac evaluation was negative, and her pain improved with a GI cocktail. However, imaging showed moderate ascites with omental haziness and nodularity, raising concern for malignancy.<br /><br />A bedside paracentesis removed 4 liters of clear ascitic fluid and proved diagnostic. Ascitic fluid analysis showed a low serum-ascites albumin gradient (0.3), malignant adenocarcinoma cells on cytology, and immunohistochemistry consistent with Müllerian origin (CK7+, PAX8+, GATA3-, CDX2-, SATB2-, ER-, PR-). Her CA-125 was markedly elevated at 1,119 U/mL, while CEA was normal, further supporting a gynecologic/peritoneal primary tumor. Pelvic ultrasound did not reveal ovarian masses.<br /><br />The case highlights that ovarian, fallopian tube, and primary peritoneal cancers can be difficult to distinguish because they arise from the same embryologic Müllerian system. Primary peritoneal cancer is rare, with an estimated annual incidence of 6.78 cases per million. In this patient, paracentesis alone was sufficient to establish the diagnosis, illustrating that ascitic fluid cytology can be highly useful when biopsy is not immediately available or safe.<br /><br />Key teaching points for hospitalists include maintaining suspicion for malignancy in patients with new ascites and recognizing that hospitalists may be the first to diagnose cancer. Bedside ultrasound-guided paracentesis can be an important diagnostic tool. Treatment for primary peritoneal cancer often follows the same approach as advanced ovarian cancer, including neoadjuvant paclitaxel and carboplatin followed by surgical debulking.

Asset Subtitle

Jennifer J. McEntee

Meta Tag

Author List Emmy Yang, Jennifer J. McEntee

Category Clinical Vignettes

Concept Cirrhotic Ascites

Concept Peritoneal Carcinomatosis

Concept Malignant Ascites

Concept Paracentesis

Concept Cytology

Distinguished Non-Finalist

Presenter Organization Unc

Presenting Author Jennifer J. McEntee

Track Adult

Keywords

primary peritoneal cancer

malignant ascites

paracentesis

Müllerian origin

adenocarcinoma

CA-125

ovarian cancer

fallopian tube cancer

ascitic fluid cytology

hospitalist diagnosis

Cirrhotic Ascites

Peritoneal Carcinomatosis

Malignant Ascites

Paracentesis

Cytology